Membership Application Form  
 
If you are an active recruiter and have been invited to become a Member by an existing member (your sponsor) we invite you to complete the Membership Application Form below.
Sponsors Name: 
Applicant's First Name: 
Last Name: 
Job Title:
Company Name:
Street Address:
City:
State:
Zip Code:
Email Address:
Web Site Address:
Business Phone:
Fax Phone:
Toll Free:
What is your  firm's total number of offices  including your headquarters office:
How many recruiters and support personal   (  project managers / researchers) are in your  company?
Is your company a member of any other  associations and if so which ones?
Best Time To Contact You:
What is your desk Specialty?

  For example: Software: Sales, Sales Support,  Management and Marketing
Please let us know why you wish to join  US-Recruiters.com. Also, please let us know  what you expect to gain from membership in  us-recruiters.com.

Birth Date - Month and Day:
Wedding Anniversary:
Date & Year you became a recruiter:
Date & Year - Business Anniversary:
What MRI/SC office did you work in?:
What was your mangers name?:
What were the dates you were there?:
Do you know an MRI Alumni we should talk to regarding joining USRC. Please provide name and contact information:
Were you CSAM Certified - Yes or No
Are you a CPC - Yes or No
Please provides us the names, telephone numbers and email addresses of two recruiters (non-members) you have recently conducted splits with:

We will be calling your referecnes prior to the final approval as a member of The US Recruiters Network.

Recruiter Number One: Name & Tele #
Recruiter Number Two: Name & Tele #

In the event a financial dispute involving a split with a member, I agree to resolve the dispute by bring my case to the US Recruiters Arbitration Board.
Yes     No

 I agree to promptly pay my Dues upon submitting this form
Yes     No

Electronic Signature (Your Full Name)
Todays Date: